Gluten-Free Diet Treatment

The dietary key to the celiac condition was first described by Samuel Gee in 1888. His contribution was the crucial understanding that: ‘If the patient can be cured at all, it must be by means of diet.’ The only cure for celiac patients is to follow a strict gluten-free diet for life. When gluten is withdrawn from the diet, the flattened villi in the lining of the small intestine gradually return to normal. Gluten can never be reintroduced. Once the body has become sensitive to gluten, it will always be affected by it. Individuals diagnosed with celiac disease and their families must consult a well-qualified nutritionist to learn how to manage the disease and follow a gluten-free diet.

Celiac disease starts with a leaky gut, which in turn is a cause of low vitamin D. Dr. Alessio Fasano has done extensive research in the area of mucosal lining of the gut. He discovered, in the early 2000’s, a trilogy present in the development of autoimmunity: genetics, triggers and intestinal permeability.
While at the same time, one must take measures to protect against nutritional and vitamin deficiencies associated with a gluten-free diet. The benefits of a ‘Coach’ to learn the correct basics through this transition cannot be over-emphasized. Eating different colours of the rainbow in every meal, under the advice of a nutritionist, health coach or a registered dietician will help to restore balance to the gut health and rebalance the immune system.

What Is a Gluten-Free Diet?

A gluten-free diet excludes all foods containing any form of wheat, barley, rye and oats. Items like roti, breads, cakes, biscuits, rusks, pasta and pastries made of wheat flour are obvious sources of gluten. Inclusion of gluten-free grains can help add variety and improve the nutritional density in gluten-free diets.

The patient’s life and food habits will need some modification. These changes may appear overwhelming at first, but as knowledge and experience increase, choosing appropriate foods becomes easier.

Gluten Free Diet Plan
FOODS CONTAINING GLUTEN FOODS THAT DO NOT CONTAIN GLUTEN
WHEAT
BARLEY
RYE
OATS
SPELT (SPECIES OF WHEAT)
KAMUT
TRITICALE
CEREALS: RICE, BUCKWHEAT, MAIZE, BAJRA
VEGETABLES
PULSES
FRUITS
NUTS
MEAT, FISH, POULTRY, EGGS
CHEESE AND MILK
OTHERS: SPIRITS, WINES, LIQUEURS AND CIDERS,
WHISKY (EXCEPT MALT WHISKY).

Great care must be taken when purchasing these flours or cereals. They may be gluten-free but if they are milled in a factory that handles gluten-containing flours there is always a risk of cross contamination.

Cross Reactivity

Often patients continue to experience symptoms even on a gluten-free diet (GFD). These symptoms could be due to either cross-contamination with gluten-containing foods or cross-reactivity . Cross-reactivity occurs when the proteins in one substance are like the proteins in another. As a result, the immune system sees them as the same. In the case of food sensitivities or allergies , cross-reactivity can occur between one food and another.
For example, about 50 percent of those who are gluten-intolerant are also sensitive to dairy.A significant immune reaction occurs when these antibodies are applied to cow’s milk, milk chocolate, whey protein, casein, yeast, oats, corn, millet, instant coffee .The consumption of cross-reactive foods as well as gluten-contaminated foods may be responsible for the continuing symptoms presented by gluten sensitive individuals . The lack of response or incomplete recovery may also be due to antibody cross-reactivity with non-gluten containing foods. These should then be treated as gluten-like proteins and should also be excluded from the diet when the GLuten free diets seem to fail.
Surprisingly, researchers are also finding that instant coffee tends to cross-react with gluten and can mimic symptoms of gluten intolerance.  The same can be said about all of the foods listed below:
* Dairy
* Chocolate
* Corn
* Hemp
* Buckwheat
* Eggs
* Soy
* Sorghum
* Millet
* Spelt
* Amaranth
* Quinoa
* Yeast
* Tapioca
* Sago
* Teff
* Oats
* Instant Coffee
* Whey
The decision to eliminate any of these is based on individual sensitivity or reactions .

Hidden Gluten

Gluten may be hiding in many common foods & ingredients:

Gulab Jamun, Jalebi, Ghevar
Heeng( aesofotida )
Mustard ( powder/ paste )
Ketchup
Soy sauce
Chocolates (some varieties)
Icecream (some varieties)
Malt vinegar
Haleem
Processed meats (some varieties)
Bhel puri

Can one cheat on a gluten free diet ?

When one has a gluten-related disorder, the treatment is a strict gluten-free diet without exception. One should not let the treatment be the trigger for more problems. In the words of Dr. Tom O’ Bryan, “you can’t be a little pregnant, you can’t have a little gluten”, in the sense that cheating once-per-month increases the risk of early death 6-fold! (ref: Lancet 2001)

Regardless if you have celiac disease or gluten sensitivity, you must take your gluten-free diet seriously.

In fact, people who are “just” sensitive to gluten can and will experience just as much or more inflammation in their bodies as someone with celiac disease, according to Dr. Tom O’Bryan.

Common cheat statements :
1. I’m not celiac, so I can eat just a little gluten here and there.
2. I’m just gluten intolerant, so I’m not worried about cross contamination.
3. I’m on a low gluten diet because I have silent celiac.
4. Gluten doesn’t bother me that much, so I just avoid it but I’m not crazy about avoiding it or anything like that.
5. I always eat gluten free, but since it’s my birthday, I’ll eat the gluten-full cake, just this once.
6. I’m going on vacation, so I don’t have time to be gluten free. I’ll resume my diet when I return.
7. It’s okay, I’ll eat the lasagna you made even though it contains gluten. I’ll just pick away the noodles. I’ll be fine.

Foods that are Naturally Gluten-Free

  • Grains, whether whole or ground flour, including buckwheat, carob, cornflour, legumes and lentils, chickpeas, Bengal gram, maize, potato, potato starch, sorghum, soy, chestnut, yam, arrowroot, cassava, rice (all types), millets (jowar, bajra, ragi), polenta, quinoa, sago, tapioca. Pure rice noodles, pure corn/rice/ millet/buckwheat pasta.
  • Breakfast cereals such as rice crispies, puffed rice, corn crispies without malt.
  • Pulses, lentils, peas, beans and their flours. .
  • Fresh or frozen plain vegetables/fruits, dried fruits and vegetables, plain canned fruits in sugar syrups or juice.
  • Vegetables canned in brine, water or juice, plain vegetables pickled in vinegar, potato crisps.
  • Dairy products including all plain cheeses (but not spreads or processed cheese), milk, dairy cream, natural yogurt, plain dried milk, evaporated and condensed milk.
  • Animal products including pure fresh or frozen meat, fish and chicken.
  • Eggs.
  • Nuts and seeds of all types, provided they are plain.
  • Yeast, yeast extract, gelatine and agar-agar.
  • Sugar in all its forms, including pure, honey, brown, syrup, molasses and treacle.
  • Fruit conserves, jams and marmalades.

What Happens If a Patient Consumes Gluten

If a patient accidentally eats a product containing gluten, they may experience abdominal pain and diarrhoea. Some people experience no signs or symptoms, but this doesn’t mean it’s not damaging their small intestines. Even trace amounts of gluten in the diet may be damaging, whether or not it causes signs or symptoms.

Going on and off a gluten-free diet could lead to serious complications such as bone loss, anaemia, vitamin deficiencies or gastrointestinal cancer, especially lymphomas.

Cooking Without Gluten

There is nothing special about gluten-free cooking other than the fact that some ingredients are replaced with alternatives that are varied and interesting. Once you familiarize yourself with the list of foods that can safely be served, it is simply a matter of making delicious dishes that everyone can enjoy. When you are new to gluten-free cooking, you will probably prefer to start with simple, no-risk dishes like grills with fresh vegetables. The celiac won’t feel isolated, if everyone in the family enjoys delicious gluten-free dishes. To cook without gluten one has to be very careful right from the stage of reading labels prior to buying and selecting the ingredients, to serving.

Wheat sensitivities in Children

1. Parental attitude’s is important. Do not transfer your anxiety to child. Remain calm
2. A positive approach helps with change in family food patterns
3. Young children less than five year old adapt better.
4. Families must be empowered with knowledge.
5. Food must be made palatable and interesting.
6. Support groups help a great deal.
7. Teachers, school authorities and children’s friends must be informed. Children may be subjected to teasing . Take care if situations arise & also prepare your child .
8. School meals and snacks need to be specially modified else arrange for permission to provide packed home food.
9. In joint families all family members and staff must be informed
10. Alternatives to favorite foods must be available
11. Healthy eating must be focused on. Discourage commercially produced processed foods .
12. Avoid introducing wheat, barley, oats and rye till your child is at least six month. Ideally, wait till the child is one year old. Avoid cow’s milk before one year.
13. Remember play dough ( plasticine) , a common item enjoyed by kids, also contains wheat flour. Watch when children with wheat sensitivity play with it and prevent them from putting it in their mouth. Insist on thoroughly washing their hands after playing.
14. Anticipate situation where there can be risk to contamination & take necessary precautions.
15. Celiac wrist band for young children or allergy alert card must be carried.
16. Accidental ingestion of gluten at parties could create panic. Simply avoid repeats.
17. If you are throwing a party, simply serve gluten free food for everyone. This is not a compromise and it can be equally delicious.
18. Watch out for emotional difficulty if your child’s behavior is changing. Don’t hesitate to seek professional help
19. Address other associated condition like type 1 diabetes, thyroid disorders etc.
20. Young teenagers & adolescences can be rebellious. They need special care and understanding. Seek help if needed.
21. Education and communication with your child must be kept up .
22. Encourage them to take control and be in charge as they grow.
23. Teach them to read labels
24. Involve them in making food choices and food preparation.
25. Seek advise on vaccination schedules keeping in mind autoimmunity issues .